WO2002028299A1 - Procede et dispositifs destines au traitement chirurgical endoscopique anterieur de pathologies de la colonne vertebrale, en particulier de la scoliose - Google Patents

Procede et dispositifs destines au traitement chirurgical endoscopique anterieur de pathologies de la colonne vertebrale, en particulier de la scoliose Download PDF

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Publication number
WO2002028299A1
WO2002028299A1 PCT/ES2000/000381 ES0000381W WO0228299A1 WO 2002028299 A1 WO2002028299 A1 WO 2002028299A1 ES 0000381 W ES0000381 W ES 0000381W WO 0228299 A1 WO0228299 A1 WO 0228299A1
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Prior art keywords
screw
spine
diseases
surgical treatment
procedure
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PCT/ES2000/000381
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English (en)
Spanish (es)
Inventor
Jesus Burgos Flores
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Jesus Burgos Flores
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Application filed by Jesus Burgos Flores filed Critical Jesus Burgos Flores
Priority to AU2000277906A priority Critical patent/AU2000277906A1/en
Priority to PCT/ES2000/000381 priority patent/WO2002028299A1/fr
Publication of WO2002028299A1 publication Critical patent/WO2002028299A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059—Cortical plates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7007—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit around the screw or hook heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/701—Longitudinal elements with a non-circular, e.g. rectangular, cross-section
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7083—Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7041—Screws or hooks combined with longitudinal elements which do not contact vertebrae with single longitudinal rod offset laterally from single row of screws or hooks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/8635—Tips of screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A61B17/8886—Screwdrivers, spanners or wrenches holding the screw head
    • A61B17/8888—Screwdrivers, spanners or wrenches holding the screw head at its central region

Definitions

  • the present specification refers to an application for an Invention Patent, relating to a procedure and apparatus used for the surgical treatment by prior endoscopic technique of diseases of the spine, especially scoliosis, whose purpose is to be configured as an applicable procedure for the treatment of diseases of the spine, using the endoscopic technique, which leads to avoiding more aggressive and traumatic surgical interventions for the patient, while using a series of devices or instruments that allow the treatment in question.
  • This invention has its application within the industry dedicated to the manufacture of devices, devices and auxiliary elements for surgery, specifically it will be used in hospital areas where patients with spinal diseases are subsidized for surgical treatment and in pathologies that need surgery.
  • the applicant is aware of the existence of degenerative, infectious, tumor or secondary deformities that require surgical treatments, in which large incisions must be made on healthy parts of the body, having only and exclusively as a mission or object making large incisions, reaching and treating the injured area.
  • the first intervention is carried out by anterior route with extensive surgical approaches, thoracotomies, or thoracophrenolumbotomies, which were associated with numerous complications and left extensive scars.
  • the correction of the deformity is made, through a new incision in the back, in order to achieve through this route, after exposing the back of the vertebrae, the placement of nails , screws and wires in different levels and, finally, to solidarity the nails and screws with two bars in order to correct the scoliosis curve.
  • the exposed bone surfaces are also screened and bone grafts are provided that are usually obtained by another incision in the hip.
  • the method and apparatus used for surgical treatment by prior endoscopic technique of diseases of the spine especially the scoliosis object of the invention, has three areas of application. Namely:
  • the proposed technique performs vertebral anterior arthrodesis and release and instrumentation in a single surgical time and endoscopically, and once the release and arthrodesis is performed of the scoliotic column endoscopically, the instrumental correction is made by using a screw inserted in each vertebral body and a bar that attached to the screws manages to stabilize the spine or correct the scoliotic deformation.
  • the "butterfly” plate which is used for endoscopic stabilization of the spine, consisting of two parallel arms, one with respect to another and united in its central part in the form of an "X".
  • a small handle that allows its introduction and intrathoracic manipulation is incorporated, and the lateral openings of the plate allow its adjustment to the screws once they are implanted in the vertebral body.
  • Figure number 1 Corresponds to the double guided scalpel that has two blades coupled, specifically two blades of number 11, which introduced through the Kirschner needle allows sufficient opening of the skin to introduce the rest of the instruments.
  • Figure number 2. Shows the object or apparatus used to carve the screw path, specifically a graduated punch with marks every 0.5 cm to allow measuring the dimension of the vertebral body and the screw.
  • Figure number 3. Corresponds to a view of the staple that is introduced through the punch in the vertebral body.
  • Figure number 4. Shows the staple impactor.
  • Figure number 5. Represents the self-cutting screw with four diameters, specifically with the diameters of 4, 5, 5.5 and 6 millimeters, provided with different lengths to adapt to the different measurements of the vertebral bodies.
  • Figure number 6. Represents the screw extension, that is to say how the screw is hollow in the proximal part, provided with a thread to allow its connection to the extension.
  • Figure number 7. Represents the threaded central rod of the extension.
  • Figure number 8. It refers to the hollow cylinder of the extension, threaded in the part ' of smaller thickness to be fixed to the screw.
  • Figure number 10. Corresponds to the hexagonal cylindrical key to thread the central rod of the extension to the screw.
  • Figure number 11. Represents the hexagonal hollow key to perform the back pressure when closing the extension on the screw, while tightening with the hexagonal cylindrical key.
  • Figures numbers 12, 13 and 14. Correspond to the connector support to guide the connectors through the extension, configured in a hollow cylindrical tube with two pins protruding distally, allowing a firm grip on the connector support when threading the two nuts of the extrathoracic end.
  • Figure number 15. Corresponds to the hexagonal connector, in which the hollow part that is introduced into the extension is hexagonal, which allows its exact adjustment to the screw, facilitating the coupling of the bar when it is stabilized in the screw, having this connector one arm with upper concavity adapted to the bar.
  • Figure number 16. Shows the cylindrical connector provided with a cylindrical hole instead of hexagonal, completing the dam on the bar, being introduced with the connector support already described.
  • Figure number 17. Represents the crenellated nut that is introduced through the extension.
  • Figure number 18. It refers to the crenellated screwdriver for threading the crenellated nut and firmly fixing the connectors to the bar.
  • Figure number 19 Represents the descent clamp, configured as a centrally threaded hollow cylinder, which allows the introduction of the screw extension through it, presenting this cylindrical body two pins that come out of the upper part and a cylindrical metal jacket that surrounds her, With a height slightly less than half of its total height, it should be noted that the pins of the descent system, when joined together separates and widens the central threaded hollow area, allowing it to be lowered by the prong until the level is the screwdriver of the crenellated dam , avoiding this maneuver that this bar descent system has to be screwed down, with substantial time savings, and once in the down position the pins are released and the shirt is lowered, thereby closing the system dam of descent on the protractor.
  • Figure number 22 Shows the compression tube, distraction, the end of which adapts to the back of the system.
  • Figure number 23, 24 and 25 Correspond to different types of "butterfly" plates.
  • Figure number 26 Represents a board connector configured as a rectangular piece that fits exactly to the outer edges of the board.
  • Figure number 27 Shows a "butterfly" plate fixed by two screws with the connectors of plate and crenellated nuts.
  • Figure number 28.- Represents the drill bit of the cylinder.
  • Figure number 29.- Represents the cylinder and the extension.
  • Figure number 30 Finally shows the cylinder attached to the connector and with the screwdriver.
  • the procedure and devices used for the surgical treatment by anterior endoscopic technique of spinal - spinal diseases, especially scoliosis, are constituted from the preparation of the path for the screw (40) that will be placed in the vertebral body, and should indicate that the patient will have a lateral recumbent posture, with the introduction of a ' Kirschner needle from the chest wall being controlled endoscopically so that the intercostal neurovascular package is not injured.
  • the aforementioned Kirschner needle is nailed in the center of the desired vertebral body, and then the double guided scalpel (1) is used that has two number 11 blades attached to it, which is inserted through the needle Kirschner, allowing sufficient opening of the skin for the introduction of the rest of the instruments, the double guided scalpel having been represented in figure number 1, configured as a central body (2) presenting emergent pronunciations (3) and (3 ') at its two ends.
  • the scalpel is removed, and again guided by the Kirschner needle a perforated punch (10) is introduced, which under the radioscopic control carves the path for the screw (40) in the vertebral body
  • the said punch (10) has one of its ends with the incorporation of the active or cutting element (16), duly graduated with marks every 0.5 cm, allowing to measure the dimension of the vertebral body and the screw (40), while on the opposite side it presents a transverse perforation (12) ,, intended to receive inside the body of a screw (15), which transversely coupled in a piece (13) that has the mission of being used as a knob or handle , presenting a longitudinal perforation (14), in which the end of the body is coupled (.11), until the perforation (12) is faced with the screw (15), and after adjusting it, the bodies (13 ) and (11) are configured as a practically monobloc body.
  • said punch (10) is graduated as marks every 0.5 cm to allow measuring the dimension of the vertebral body and the screw (40) to be used later, the object mentioned being represented in figure number 2.
  • the handle or handle (13) is removed after releasing the screw adjustment (15), and through it a staple (20) shown in figure number 3 is passed, which fits exactly to the diameter of the punch, and is nailed into the vertebral body with the help of a staple impactor (30), represented in figure number 4.
  • the punch (10) is removed and the screw (40) is placed.
  • the clip (20) represented in figure number 3 is configured as a circular plan body, presenting an annular body (21) provided with a central perforation (22), emerging from the lower area four threaded pronunciations (23 ) situated equidistant.
  • the staple impactor (30) is configured as a cylindrical body (31), which has at one of its ends a thickened area (32), configured as a perimeter thickened that forms a step with the body (31), presenting in the opposite end a longitudinal perforation (33).
  • the screw (40) is self-cutting, as can be seen in Figures 5 and 9, presenting a helically threaded body (41), provided at one of its ends with a self-cutting tip, and on the opposite of an adjustment head (42), capable of attaching a hexagonal piece (43) and a crenellated piece (44) for fixing to various tools, the self-cutting screw having four diameters defined as 4, 5, 5.5 and 6 mlm, and having different lengths to accommodate different measures of the 'vertebral bodies.
  • the screw (40) has an extension
  • the body (51) constituting the extension (50) of the screw (40) has a hexagonal configuration (52), being hollow inside.
  • the screw (40) subsequently has the helically threaded area, the trunk-conical area of greater diameter (42) mentioned above, and on it a hexagonal part (43) and then a smooth cylindrical zone referenced with (45) and finally a threaded area (44) provided with two facing recesses.
  • Said screw (40) has a hollow configuration with an internal thread in the proximal part to allow its connection to the extension shown in figure 6 mentioned above, which internally has a body (60) configured as an elongated body (62) , which has at one of its ends the threaded configuration (63), coinciding with the existing thread inside the screw (40) and the parts located next to it referenced with (42), (43), (44 ) and (45).
  • the body (62) has an external perimeter threading (61) and this element (60) is introduced inside the body (51) which has a larger diameter and a longitudinal perforation, having been represented in figures 7 and 8 the independent parts that have subsequently been reflected in figure number 6, mounted together and attached to the screw (40) in figure number 9.
  • the mission of the pieces (50) and (60) is that when they are in solidarity with the screw (40) they facilitate handling outside the thorax.
  • the hexagonal cylindrical wrench (70) represented in figure number 10 configured as an elongated body (71) having six facets or longitudinal faces constituting its external perimeter, and that has at one of its ends a flat transverse zone (72), for example a quadrangular zone with vertices and blunt edges for the specialist's performance, while the hexagonal hollow key (80) is configured as a elongated body (81) that has a transverse perforation (82) in the lower middle area, and is finished off in a hexagonal configuration (83), while on the opposite side it has a circular plan body (84) from which two angular extensions (85) and (85 ') directed in antagonistic directions are derived.
  • the hollow cylinder has two small battlements at one end, which coincide with the two nicks of the screw (40), allowing its exact adjustment with the screw (40), and. increasing the contact surface and its screwing from outside the thorax by the hexagonal part of the other end, as shown in figure number 11.
  • the central rod is thickened proximally, so as to prevent the hollow cylinder from coming out, ensuring that it is firmly anchored when it is screwed into the hollow part of the screw (40), as shown in Figure 9.
  • the screw (40) When the screw (40) is connected to the extension formed by the hollow cylindrical body and the rod, it can be introduced into the vertebral body, handling them from the outside of the thorax with the hollow hexagonal key (80).
  • the screw (40) of the size chosen with the protractor (50) is passed through the thoracic incision and threaded into the vertebral body in the hole carved by the punch (10) in the center (22) of the body (21) of the staple (20)
  • the next step is to place the first of the two bar connectors or hexagonal connector (100) represented in figure number 15, configured as an elongated body, which has an area of the it adopting the circular configuration, circling the internal zone (101) of hexagonal plan, which has a transverse recess (102) on one side, performing this operation through the protrusion protruding out of the thorax.
  • a 'connector (90) support is provided, which is configured as a piece to guide the connectors through the extension, configured as a ' 1 cylindrical hollow tube (91) with two pins (92) and (92 ') protruding distally, allowing the connector support (90) a firm grip when threading the two nuts
  • the first of the connectors (100) or hexagonal connector has the hollow part (101) that is inserted into the hexagonal extension, which allows its exact adjustment to the hexagonal part of the screw (40), facilitating the coupling to the bar remain stable by its hexagonal adjustment, this connector having an arm or pronunciation with cavity (102) in the upper part, adapted to the bar (150) represented in figure number 21.
  • the second connector (110) or cylindrical connector has a configuration similar to the connector (100), but unlike this it has a circular perforation (112) instead of the hexagonal perforation (101) of the connector (100) and the curved area (113) is directed downward forming a hollow cylindrical zone the adjacent position of the pieces (100) and (110) in their pronunciation, configuring a dam on the bar (150), being introduced with the connector support described above and once the bar (150) is supported with the two connectors (100) and (110) a crenellated nut is inserted, just as is shown in figure number 17, referenced with (120) and presenting a circular perforation (121) and the recesses (122) constituting the battlement, the introduction being made through the extension with its crenellated screwdriver, represented in figure number 18 , which has been referenced in a general way with (130), presenting a body (131) and having at one of its ends an area (132) coinciding with the crenellated nut of the crenellated nut (120), being able to thread the
  • (150) is high in the following screws, posing problems to make its descent and couple the connectors (100) and (110) on it, for which a system of descent of the second connector, as well as the crenellated nut is provided and the crenellated screwdriver, referenced respectively with (110), (120) and (130).
  • the descent clamp shown in figure number 19, referenced with (140) in shape In general, it is configured as a centrally threaded hollow cylinder, which allows the extension to be introduced
  • the descent clamp (140) presenting the general shape of a hollow cylinder, provided with two pins (144) and (144 ') emerging from the top, having a cylindrical metal jacket (142), which surrounds the general body (141) having a length slightly less than half the total height of the body (141), the jacket (142) having a knurled band (143) in its upper area.
  • the pins (144) and (144 ') constituting the possibility of lowering them together, separate and widen the central threaded hollow area, allowing it to be lowered by the extension (50) to the level of the screwdriver (130) of the crenellated dam
  • the pins (144) and (144 ') are released and the jacket (142) is lowered, thereby closing the dam of the descent device on the extension (50), and at this time the bar is lowered to the thread next to the upper connector (110), the crenellated nut (120) and the screwdriver (130) to which the screw (40) can be threaded, and at this time the descent device can be removed because the position of the rod (150) and the connector (110) in collaboration with the connector (10) is secured by the crenellated nut (120).
  • Bar assembly complete on all the necessary screws, in case of deformities, it is sometimes necessary to unravel the bar, for which some elements of grip bar are provided, by means of two support points facing a central third that is threaded from the outside.
  • the hollow tubular body (161) allows the crenellated screwdriver (130) to be inserted inside, and the introduction of two tubes in two successive screws allows compression or distraction of these made from the outside of the thorax, ensuring the position, closing the nut crenellated (120) with the screwdriver (130) that remains in position.
  • the final snap closure is secured by counterpressing with the hexagonal hollow wrench (80) of the extension (50), while the crenellated screwdriver (130) is used to close the nut (120), being terminated by removing the extension and the screwdriver from the crenellated nut, keeping the compression tube in position.
  • this operation can be carried out, performing the steps opposite to those followed in its implementation, first placing the connector support, and through it the small screw with the crenellated washer is removed, using the corresponding screwdriver, to subsequently insert the crenellated screwdriver, and inside it the extension element of the screw that is fixed, removing the crenellated nut and the upper connector when removing the connector support.
  • the "butterfly" plate depicted in figures numbers 23, .24 and 25, which is used for endoscopic stabilization of the spine, consists of an elongated configuration monobloc body generally referenced with (170), which is presented in the central zone two longitudinal recesses (172) and (172 '), located on the general body (171), adopting the recesses (172) and (172') in the internal zone, a configuration similar to a semicircular arch, emerging from the upper face of the central area, a pronunciation (173) applicable as a handle, allowing its intrathoracic introduction and manipulation, while the zones configured as lateral openings, grooves or recesses (172) and (172 '), are intended to facilitate the adjustment of the screws a Once they have been implanted in the vertebral body.
  • the placement procedure consists in that once the endoscopic surgical gestures necessary to treat the vertebral lesion have been performed, the screws (190) are placed in the adjacent vertebral bodies, following the steps indicated in the guideline described earlier in the procedure, and in that moment is. choose the appropriate plate (170), measuring it on the screw extensions outside the chest, and introducing the plate
  • the plate connector shown in Figure 26 is inserted, which is configured as a part generally referenced with (180), • which has a plantar configuration rectangular, having a circular perforation (181) in its central area, and presenting on the reverse extensions (182) getting these extensions facilitate the exact adjustment to the outer edges of the plate (170).
  • the final closing of the assembly is carried out by counterpressing with the hexagonal hollow key of the extension and finally the extensions are removed.
  • the procedure contemplated by this invention allows the use of cylinders for vertebral body arthrodesis, that is to say that once the endoscopic dissectomy is performed at the desired level, a Kirschner needle is inserted, through the costal wall , checking with the optics that the intercostal vasculonervious package is not injured, verifying radioscopically that the needle has a correct direction in the intervertebral disc and at this moment with the help of the double scalpel (1) guided by the needle the opening of the thoracic wall, the scalpel is removed (1) and the drill bit (204) attached to a coupling (203) of a cylindrical body (201), having a transverse handle (202), having been referred to with (200) the general context of the drill bit in question, also passing the connector support that is hammered slightly to fix the two pins in the disc space, distracting the element and the vertebral bodies.
  • Kirschner and the cylinder bed is carved with the drill bit under radioscopic vision.
  • the drill bit (200) is removed and the cylinder tap is inserted, adjusted to the size of the cylinder, and which will tilt and facilitate the introduction of the cylinder itself.
  • the cylinder (205) has a longitudinal perforation and has two larger circular holes facing each other, two on the upper face that will be in contact with the upper vertebral body, and two lower ones in contact with the lower vertebral body, and around the
  • the cylinder body shows the existence of a helical groove, which allows its precise adjustment to the vertebral body.
  • the said cylinder (205) filled with bone grafts will allow bone growth between the vertebral bodies and the arthrodesis, and being the flat cylinder (205) in the central part where it is threaded and peripherally with two vertical grooves that allow threading and adjusting the extension (51) in the same way as was done with the screw, adapting more externally to the screwdriver (130) through its body (131), this crenellated end being with which the final implantation of the cylinder (205) is performed.

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  • Orthopedic Medicine & Surgery (AREA)
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  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un procédé et des dispositifs destinés au traitement chirurgical endoscopique antérieur de pathologies de la colonne vertébrale, en particulier de la scoliose. Ce procédé consiste à réaliser le traitement de correction à l'aide de dispositifs ou d'instruments composés de cylindres avec des greffons osseux formant les fixations vertébrales antérieures, de plaques métalliques servant à stabiliser la colonne et de barres servant à corriger les déformations, en collaboration avec différents instruments pouvant être utilisés spécifiquement pour ce type d'intervention.
PCT/ES2000/000381 2000-10-05 2000-10-05 Procede et dispositifs destines au traitement chirurgical endoscopique anterieur de pathologies de la colonne vertebrale, en particulier de la scoliose WO2002028299A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU2000277906A AU2000277906A1 (en) 2000-10-05 2000-10-05 Method and apparatus for surgical treatment of diseases of the vertebral column,especially scoliosis, using anterior endoscopic technique
PCT/ES2000/000381 WO2002028299A1 (fr) 2000-10-05 2000-10-05 Procede et dispositifs destines au traitement chirurgical endoscopique anterieur de pathologies de la colonne vertebrale, en particulier de la scoliose

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/ES2000/000381 WO2002028299A1 (fr) 2000-10-05 2000-10-05 Procede et dispositifs destines au traitement chirurgical endoscopique anterieur de pathologies de la colonne vertebrale, en particulier de la scoliose

Publications (1)

Publication Number Publication Date
WO2002028299A1 true WO2002028299A1 (fr) 2002-04-11

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PCT/ES2000/000381 WO2002028299A1 (fr) 2000-10-05 2000-10-05 Procede et dispositifs destines au traitement chirurgical endoscopique anterieur de pathologies de la colonne vertebrale, en particulier de la scoliose

Country Status (2)

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AU (1) AU2000277906A1 (fr)
WO (1) WO2002028299A1 (fr)

Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003032851A1 (fr) * 2001-10-18 2003-04-24 Ldr Medical Plaque pour dispositif d'osteosynthese et procede de preassemblage
US8845691B2 (en) 2003-09-01 2014-09-30 Ldr Medical Osseous anchoring implant with a polyaxial head and method for installing the implant
US9326795B2 (en) 2001-12-12 2016-05-03 Ldr Medical Implant for osseous anchoring with polyaxial head
US20160183983A1 (en) * 2014-12-09 2016-06-30 John A. Heflin Spine alignment system
US9675389B2 (en) 2009-12-07 2017-06-13 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US10548740B1 (en) 2016-10-25 2020-02-04 Samy Abdou Devices and methods for vertebral bone realignment
US10575961B1 (en) 2011-09-23 2020-03-03 Samy Abdou Spinal fixation devices and methods of use
US10695105B2 (en) 2012-08-28 2020-06-30 Samy Abdou Spinal fixation devices and methods of use
US10751187B2 (en) 2007-06-08 2020-08-25 Ldr Medical Intersomatic cage, intervertebral prosthesis, anchoring device and implantation instruments
US10857003B1 (en) 2015-10-14 2020-12-08 Samy Abdou Devices and methods for vertebral stabilization
US10918498B2 (en) 2004-11-24 2021-02-16 Samy Abdou Devices and methods for inter-vertebral orthopedic device placement
US10973648B1 (en) 2016-10-25 2021-04-13 Samy Abdou Devices and methods for vertebral bone realignment
US11006982B2 (en) 2012-02-22 2021-05-18 Samy Abdou Spinous process fixation devices and methods of use
US11173040B2 (en) 2012-10-22 2021-11-16 Cogent Spine, LLC Devices and methods for spinal stabilization and instrumentation
US11179248B2 (en) 2018-10-02 2021-11-23 Samy Abdou Devices and methods for spinal implantation

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ES2086391T3 (es) * 1990-02-08 1996-07-01 Stryker Corp Dispositivo de osteosintesis multifuncional del raquis.
US5360431A (en) * 1990-04-26 1994-11-01 Cross Medical Products Transpedicular screw system and method of use
US5129899A (en) * 1991-03-27 1992-07-14 Smith & Nephew Richards Inc. Bone fixation apparatus
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ES2141217T3 (es) * 1993-02-10 2000-03-16 Sulzer Spine Tech Inc Juego de herramientas quirurgicas para estabilizacion de la columna vertebral.
US5425490A (en) * 1994-01-18 1995-06-20 Goble; E. Marlowe Instrument with dual holding feature
WO1997007743A1 (fr) * 1995-08-25 1997-03-06 Grotz R Thomas Stabilisateur d'articulations utilisable en medecine humaine

Cited By (35)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2003032851A1 (fr) * 2001-10-18 2003-04-24 Ldr Medical Plaque pour dispositif d'osteosynthese et procede de preassemblage
US9326795B2 (en) 2001-12-12 2016-05-03 Ldr Medical Implant for osseous anchoring with polyaxial head
US8845691B2 (en) 2003-09-01 2014-09-30 Ldr Medical Osseous anchoring implant with a polyaxial head and method for installing the implant
US11096799B2 (en) 2004-11-24 2021-08-24 Samy Abdou Devices and methods for inter-vertebral orthopedic device placement
US11992423B2 (en) 2004-11-24 2024-05-28 Samy Abdou Devices and methods for inter-vertebral orthopedic device placement
US10918498B2 (en) 2004-11-24 2021-02-16 Samy Abdou Devices and methods for inter-vertebral orthopedic device placement
US10751187B2 (en) 2007-06-08 2020-08-25 Ldr Medical Intersomatic cage, intervertebral prosthesis, anchoring device and implantation instruments
US10543107B2 (en) 2009-12-07 2020-01-28 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US11918486B2 (en) 2009-12-07 2024-03-05 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US10610380B2 (en) 2009-12-07 2020-04-07 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US10945861B2 (en) 2009-12-07 2021-03-16 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US9675389B2 (en) 2009-12-07 2017-06-13 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US10857004B2 (en) 2009-12-07 2020-12-08 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US10575961B1 (en) 2011-09-23 2020-03-03 Samy Abdou Spinal fixation devices and methods of use
US11517449B2 (en) 2011-09-23 2022-12-06 Samy Abdou Spinal fixation devices and methods of use
US11324608B2 (en) 2011-09-23 2022-05-10 Samy Abdou Spinal fixation devices and methods of use
US11006982B2 (en) 2012-02-22 2021-05-18 Samy Abdou Spinous process fixation devices and methods of use
US11839413B2 (en) 2012-02-22 2023-12-12 Samy Abdou Spinous process fixation devices and methods of use
US11559336B2 (en) 2012-08-28 2023-01-24 Samy Abdou Spinal fixation devices and methods of use
US10695105B2 (en) 2012-08-28 2020-06-30 Samy Abdou Spinal fixation devices and methods of use
US11173040B2 (en) 2012-10-22 2021-11-16 Cogent Spine, LLC Devices and methods for spinal stabilization and instrumentation
US11918483B2 (en) 2012-10-22 2024-03-05 Cogent Spine Llc Devices and methods for spinal stabilization and instrumentation
US10736668B2 (en) 2014-12-09 2020-08-11 John A. Heflin Spine alignment system
US20160183983A1 (en) * 2014-12-09 2016-06-30 John A. Heflin Spine alignment system
US10034690B2 (en) 2014-12-09 2018-07-31 John A. Heflin Spine alignment system
US11419637B2 (en) 2014-12-09 2022-08-23 John A. Heflin Spine alignment system
US11246718B2 (en) 2015-10-14 2022-02-15 Samy Abdou Devices and methods for vertebral stabilization
US10857003B1 (en) 2015-10-14 2020-12-08 Samy Abdou Devices and methods for vertebral stabilization
US10744000B1 (en) 2016-10-25 2020-08-18 Samy Abdou Devices and methods for vertebral bone realignment
US11259935B1 (en) 2016-10-25 2022-03-01 Samy Abdou Devices and methods for vertebral bone realignment
US11752008B1 (en) 2016-10-25 2023-09-12 Samy Abdou Devices and methods for vertebral bone realignment
US10973648B1 (en) 2016-10-25 2021-04-13 Samy Abdou Devices and methods for vertebral bone realignment
US10548740B1 (en) 2016-10-25 2020-02-04 Samy Abdou Devices and methods for vertebral bone realignment
US11058548B1 (en) 2016-10-25 2021-07-13 Samy Abdou Devices and methods for vertebral bone realignment
US11179248B2 (en) 2018-10-02 2021-11-23 Samy Abdou Devices and methods for spinal implantation

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